Organization
BIOVANTRA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD RUSSELL LOCKE M.D. (MANAGING MEMBER)
(352) 861-2296
Entity
Organization
Contact information
Practice address
9401 SW HIGHWAY 200 STE 502, OCALA, FL 34481-9650
(352) 861-2296
(352) 671-2737
Mailing address
PO BOX 772287, OCALA, FL 34477-2287
(352) 861-2296
(352) 671-2737
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
800025941
FL
Other
Enumeration date
05/05/2008
Last updated
05/08/2018
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